BASIS
AND OBJECTIVES: The practice of physical exercises, besides avoiding idleness,
contributes expressively for the maintenance of the physical fitness of the
elderly. The objective of this study was to verify the effect of hydrogymnastics
on the physical fitness and the elderly health.METHODOLOGY: A controlled assay on 74 elderly women with no regular physical
activity was performed. A group of 37 women had two weekly hydrogymnastics classes
during 3 months and other 37 women served as control. The physical fitness was
evaluated though the Rikli and Jones (1999) test battery, where the following
parameters were evaluated: power and resistance of the lower members (to sit
down and to stand up), power and resistance of the upper members (forearm flexion),
lower members flexion (at sitting position, to touch lower members), physical
mobility  velocity, agility and balance (to stand up, to walk 2.44 m and to
sit back down), flexibility of the upper members (reading up the back with hands)
and aerobic resistance (6-minute walk). The test battery was applied before
the beginning of classes and at the end of the program 3 months later. The groups
had similar behavior with regard to age, IMC, familiar income and educational
level.RESULTS: During the three months, 30 women of each group were followed,
sampling loss of 18.9%. In the hydrogymnastics group, a better performance in
all post-tests was observed, when compared to results of the own group in the
pre-test and to the control group in the post-test (p < 0.05).CONCLUSION: One concludes that the practice of hydrogymnastics for elderly
women with no regular physical exercises, contributes to the improvement of
the physical fitness and elderly health.

The aging,
unavoidable process of all human beings, leads to a progressive loss of the
organism functional fitness, increasing the risk of idleness1. Those
alterations, in the bio-psycho-social domains, threaten the life quality of
the elderly by limiting their capacity to perform vigorously daily activities
and by increasing the vulnerability of their health2.

The idleness,
which tends to follow the aging and has been target of pressure from the technological
advancements occurred in the last decades, is also an important risk factor
for chronic-degenerative diseases, especially the cardiovascular affections,
main cause of elderly death3,4. The practice of physical exercises,
besides avoiding idleness, contributes expressively for the maintenance of the
physical fitness of the elderly with regard to both their health and their functional
capacities3. However, physical exercises may present some limitations
for the elderly due to the physiological modifications imposed by the aging
process. The hydrogymnastics shows some advantages for this populational group
with the utilization of the water physical properties, enabling a better yield
for the elderly, besides showing less risks6. Despite these potential
benefits, the hydrogymnastics practice for the elderly has been yet not deeply
studied. Thus, we intend to evaluate the effects of the hydrogymnastics on the
functional physical fitness in elderly women with no regular physical activity.

METHODOLOGY

A controlled,
prospective study was performed at the Physical Education School from the Pernambuco
University (ESEF-UPE), Recife (PE), Brazil, in the period from February to May
2001. Women above 60 years of age who have not practiced any regular physical
exercise program in the last 12 months were recruited from two low-income communities
of the city of Recife. Those women with any medical contraindication for the
practice of exercises and carrier of neuro-motive deficiency, not approved in
the medical evaluation, were excluded from the program, besides the women who
did not accomplish more than 90% of the physical activity program established.

The size
of the sample was calculated for a power of 80% and a type-I error of 5%. An
average variation of 20% between the pre and post test "sitting down and standing
up" was admitted, and the size of the sample was calculated among 50 participants.
Once a maximal casuistic loss of around 40% was estimated, one has chosen to
elevate the casuistic number to 74 participants.

The participants
were divided in two distinct groups, according to the residence site. 45-minutes
duration hydrogymnastics classes were ministered to the training group (n =
37) twice a week, during a period of 12 weeks. The classes were ministered always
in the morning in a swimming pool with 1.20 m depth and 25 m x 12.5 m and the
water temperature ranged from 26 to 28°C. The classes were composed of 4
phases: 1 - Warming up (elongation and flexibility, static method, during 5
minutes); 2 - Aerobic exercises (running, dislocations and combined movements
of arms and legs in intervals, 1 minute for the activity and 1 minute for recovering,
during 20 minutes); 3 - Localized exercises (power/resistance of the upper and
lower members and abdominal exercises using the water resistance, during 15
minutes) and 4 - Relaxation (5-minute slow walking).

The physical
fitness was measured through the test battery developed by Rikli and Jones7,
where the members' resistance and power, the physical mobility and flexibility
(velocity, agility and dynamic balance) and the aerobic resistance were evaluated
respectively through the following tests: "to stand up and to sit down", "forearm
flexion", "chair sit-and-reach", "to sit down, to walk 2.44 minutes and to sit
back down", "to touch the back" and "6-minute walk". All tests were performed
all over again at the same conditions 3 months after the hydrogymnastics classes.

In the analysis,
the results were compared between and within the groups, through the analysis
of variance with replicates and the t-Student test was used for pairing
samples. The computer program SPSS was used and the tests with p value
smaller than 0.05 were considered as significant.

The present
study has followed the establishments of the Helsinki Declaration, and resolution
196/96 of the Health National Council. The project was previously approved by
the Ethics Committee from the Pernambuco University and only participants who
have given their written consent were admitted.

RESULTS

From the
74 participants initially recruited for the research, who performed the tests
battery at the "baseline", 14 of them (18.9%) did not repeat the post-test.
In the study-group, 7 participants did not accomplish the 3 months of hydrogymnastics
classes, all by the following health reasons: cerebral vascular disease (2),
surgery (2), familiar disease (2) and traumatism (1). In the "control" group,
7 participants did not respond the calling for the performance of the post-test.

The groups
had been comparable in the "baseline" with regard to age, familiar income and
educational level, according to table 1.

The groups
"study and control" showed the same results in the "test of standing up and
sitting down" at the beginning of the research. Three months later, it was observed
a better performance of group submitted to the hydrogymnastics training (table
2).

With regard
to the "forearm flexion" test, it was observed a better performance of group
submitted to hydrogymnastics classes (table 3).

In table
4, it was observed results of the "chair sit-and-reach" test. Those results
also showed significant differences after 3 months of hydrogymnastics training.

In the "to
sit down, to walk 2,44 m and to sit back down" test, the results of the group
were also different between tests (table 5).

With regard
to the "reaching up the back" test, the results were better for the group submitted
to the hydrogymnastics training (table 6).

In the "6-minute
walk" test, the performances were also better for the group submitted to the
hydrogymnastics training (table 7).

DISCUSSION

A significant
improvement in all tests of applied physical fitness after the hydrogymnastics
training was verified in our study. Those results seem to confirm the importance
of the practice of physical exercises, in this case, the hydrogymnastics, on
the maintenance and improvement of the physical fitness of elderly women who
live their lives with no regular exercise practice.

We believe
that the employed methodology provides reliance to our results, once both groups
studied were comparable in their main socioeconomic and biological variables,
besides tests have been applied with the same technique and the same instructors
as well, in both at the initial moment and three months later.

Several
tests for the assessment of the physical fitness on elderly adult are currently
described. We have selected the Rikli and Jones 7 test for being
more complete, practical, replicable and of low operational cost. Another advantage
is that it deals about a test already approved8.

In the literature
we have made use of, no studies with similar methodology that have evaluated
the effects of hydrogymnastics on the functional physical fitness of elderly
women were found. This fact made the comparative analysis of our results more
difficult.

In the first
test applied, the "to sit down and to stand up" test, we have attempted to verify
basically the power and the resistance of the lower body segment9.
Our results are similar to results from Frontera et al.10,who
verified a power gain in the elderly of up to 227% after a 12-weeks training.
Hagber et al.11 and Hicks et al.12, also
verified a power gain in elderly women and men who performed muscular power
training during 12 to 26 weeks. For some authors, this test shows a hindrance
for its performance and results interpretation: the back pain, frequent complaint
in this population that sometimes makes it infeasible. In our study, such complaint
was not observed from any of the patients.

The forearm
flexion test assesses the muscular power and resistance of the body upper segment.
Our results are in agreement with the observations of McCartney et al.13
that, despite the decrease on the power of the body upper segment with the aging,
this alteration may be modified with the exercise practice.

The test
of "chair sit-and-reach" assesses with accuracy the flexibility of the body
lower segment (hips and vertebral spine flexion)9. In our study,
patients submitted to the hydrogymnastics training began performing this test
with higher ability. Hoerger and Hopkins14 in a controlled study
with women with 55 to 77 years of age, also verified improvement on the score
of this test after a program of elongation, walking and dance movements during
12 weeks. It is likely that the flexibility, once properly worked in water exercises,
has justified those findings.

The test
of " to reach behind the back" seeks to evaluate the shoulder general movement:
adduction, abduction and internal and external rotation. In our results this
test has also shown significant changes after a period of three months of hydrogymnastics
training. Hubley-Kozey et al.15 observed significant improvements
on the movement amplitude of several articulations (neck, shoulder, elbow, wrist,
hip, knee and ankle) in elderly individuals who participated of a regular exercises
program. With the osteo-articular deterioration process, which is sped up from
the 65 years of age on, a slight increase on the movement amplitude from physical
training works, may represent an important gain of life quality for these people16.

The test
of "to sit down, to walk 2.44 m and to sit back down" assesses mobility, velocity
and dynamic balance. Our results have also demonstrated the positive effect
of the hydrogymnastics classes on the performance of the participants of this
test. Lord and Castell17 reported improvements on the balance of
the elderly after practice of regular physical exercises during 10 weeks. Topp
et al.18 observed a tendency of improvement of the balance,
although not significant from the statistical point of view, in elderly submitted
to a power training during 12 weeks. Hoerger and Hopkins14, observed
an increase of 12% of the mobility in elderly at the end of a 12-weeks duration
physical exercise program.

The test
of "6-minute walk" assesses the aerobic resistance, important capacity for people
to be able to perform daily tasks such as to walk, to go shopping or recreation
activities. This test had been successfully used to evaluate the physical resistance
of patients carrier of several clinical conditions; however, only recently it
was approved for the use on healthy elderly people19. An outstanding
increase on the aerobic resistance of the hydrogymnastics group was also observed
in our study. The physical exercise increases the aerobic power from 10 up to
40%, especially through the increment of the artery-venous difference of oxygen,
systolic volume, cardiac debt and plasmatic and blood volume20.

Although
we have performed the physical training for a period of time relatively short,
3 months, we have observed expressive results. According to Spirduso2,
the improvement on the power quantity occurs relatively quickly, in an average
time of 2 months, data corroborated by Frontera et al.10.
Some authors admit that the power gain in the elderly occurs more intensively
than in younger people2. They justify that old-aged people usually
begin an exercise program in poorer conditions if compared to younger people,
what provides gains relatively higher. However, according to Matsudo21,
the effects of the training programs in the elderly on the musculature strengthening
are quickly lost with the activity suspension, with losses of 32% in power within
4 weeks after the training suspension. Thus, they recommend the maintenance
of those programs in order for those positive results to be long lasting. In
our study, we recommend to all participants, including the control group, the
continuous and regular participation on physical exercises programs, especially
the hydrogymnastics.

The drop
on the physical fitness with the aging is an unavoidable fact, which progressively
begins, around the fifth decade of life. However, several other studies like
ours, point out to the benefits of physical exercise programs for the elderly
as an important prophylactic procedure in order to preserve or to delay as possible
the aging effects on the physical fitness21,22. Besides the improvement
on the physical fitness, the physical activity also contributes for the reduction
of the morbid-mortality of the elderly23,24.

CONCLUSIONS

Hydrogymnastics
programs contribute for the improvement and maintenance of the elderly physical
fitness. However, further studies are required in order to evaluate the effects
herein approached and other effects of the hydrogymnastics on the elderly physical
fitness.

All the
authors declared there is not any potential conflict of interests regarding
this article.